Journal of Central Nervous System Disease最新文献

{"title":"Central nervous system, spinal root ganglion and brachial plexus involvement in leprosy: A prospective study.","authors":"Sumit Verma,&nbsp;Ravindra Kumar Garg,&nbsp;Imran Rizvi,&nbsp;Hardeep Singh Malhotra,&nbsp;Neeraj Kumar,&nbsp;Amita Jain,&nbsp;Swastika Suvirya,&nbsp;Anit Parihar,&nbsp;Rajesh Verma,&nbsp;Praveen Kumar Sharma,&nbsp;Shweta Pandey,&nbsp;Ravi Uniyal,&nbsp;Shantanu Prakash","doi":"10.1177/11795735221135477","DOIUrl":"https://doi.org/10.1177/11795735221135477","url":null,"abstract":"<p><strong>Background: </strong>Leprosy is primarily a disease of peripheral nerves. Some isolated case reports and case series have communicated imaging changes in the central nervous system (CNS) and brachial plexus in patients with leprosy.</p><p><strong>Objectives: </strong>To study the neuroimaging abnormalities in patients with lepra bacilli-positive neuropathy in the context of CNS, spinal root ganglion, and brachial plexus.</p><p><strong>Design: </strong>Prospective observational study.</p><p><strong>Methods: </strong>We screened newly-diagnosed patients with multibacillary leprosy presenting with neuropathy. Patients with bacilli-positive sural nerve biopsies were included in the study and subjected to magnetic resonance imaging (MRI) of the brain and spinal cord.</p><p><strong>Results: </strong>A total of 54 patients with bacteriologically confirmed multibacillary leprosy were screened; <i>Mycobacterium leprae</i> was demonstrated in the sural nerve biopsies of 29 patients. Five patients (5/29; 17.24%) had MRI abnormalities in CNS, spinal root ganglion, and/or brachial plexus. Three patients had MRI changes suggestive of either myelitis or ganglionitis. One patient had T2/FLAIR hyperintensity in the middle cerebellar peduncle while 1 had T2/FLAIR hyperintensity in the brachial plexus.</p><p><strong>Conclusion: </strong>CNS, spinal root ganglion, and brachial plexus are involved in patients with leprous neuropathy. Immunological reaction against <i>M leprae</i> antigen might be a plausible pathogenetic mechanism for brachial plexus and CNS imaging abnormalities.</p>","PeriodicalId":15218,"journal":{"name":"Journal of Central Nervous System Disease","volume":" ","pages":"11795735221135477"},"PeriodicalIF":4.8,"publicationDate":"2022-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/fe/eb/10.1177_11795735221135477.PMC9583215.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40655030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Natalizumab extended-interval dosing in multiple sclerosis to mitigate progressive multifocal leukoencephalopathy risk: initial study evidence and real-world experience.","authors":"Julian Perncezky,&nbsp;Johann Sellner","doi":"10.1177/11795735221135485","DOIUrl":"https://doi.org/10.1177/11795735221135485","url":null,"abstract":"<p><p>The high efficacy of natalizumab in the treatment of relapsing-remitting multiple sclerosis (MS) is without controversy. Indeed, effective disease control was not only demonstrated in the pivotal trials but has been corroborated impressively in real-world observations. This monoclonal IgG4 antibody blocks the α4β1 integrin-mediated leukocyte-endothelial interaction and thereby inhibits the migration of immune cells to the brain parenchyma. However, treatment with natalizumab carries the risk of progressive multifocal leukoencephalopathy (PML). This potentially lethal side effect is a significant limitation for treatment initiation and long-term therapy. Natalizumab is given intravenously or subcutaneously in the standard dose of 300 mg every 4 weeks, allowing drug concentrations at levels that ensure continuous α4β1 integrin receptor saturation on the surface of immune cells. Extended-interval dosing (EID) is an emerging treatment approach that aims to mitigate the natalizumab-related PML risk by prolonging the standard infusion intervals to 6 weeks or even more. This treatment approach may abrogate the PML risk due to improved immune surveillance within the central nervous system while maintaining clinical efficacy. Moreover, even an individual interval dosing can be envisioned based on the availability of a biomarker that is capable of monitoring both safety and efficacy aspects. This review summarizes the early and encouraging evidence for EID from observational and randomized-controlled trials and discusses current limitations and upcoming challenges for introducing a tailored treatment approach.</p>","PeriodicalId":15218,"journal":{"name":"Journal of Central Nervous System Disease","volume":" ","pages":"11795735221135485"},"PeriodicalIF":4.8,"publicationDate":"2022-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ee/c2/10.1177_11795735221135485.PMC9580073.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40655029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and efficacy of endovascular thrombectomy in patients with severe cerebral venous thrombosis: A meta-analysis.","authors":"Gaurav Nepal,&nbsp;Sanjeev Kharel,&nbsp;Riwaj Bhagat,&nbsp;Megan A Coghlan,&nbsp;Jayant K Yadav,&nbsp;Stella Goeschl,&nbsp;Rajan Lamichhane,&nbsp;Subash Phuyal,&nbsp;Rajeev Ojha,&nbsp;Gentle S Shrestha","doi":"10.1177/11795735221131736","DOIUrl":"https://doi.org/10.1177/11795735221131736","url":null,"abstract":"<p><strong>Background: </strong>Cerebral venous thrombosis (CVT) is a rare thrombotic condition which is traditionally treated with anti-coagulation therapy. Subsets of patients with severe CVT have been treated with endovascular thrombectomy (EVT). Despite the high estimated mortality associated with severe CVT, there has been only one randomized control trial done regarding safety and efficacy of EVT in severe CVT compared to standard medical management. Evidence in this area is lacking.</p><p><strong>Objective: </strong>The aim of this systematic review is to analyze all existing literature and generate robust information regarding the role of EVT in the management of patients with severe CVT.</p><p><strong>Methods: </strong>This systematic review and meta-analysis followed PRISMA guideline. PubMed, Embase, Google Scholar, and CNKI were searched for eligible studies from 2007 to 2021. Safety and efficacy of EVT were evaluated by meta-analyzing recanalization status, the good functional outcome at follow-up, recurrent CVT, new hematoma. A pooled proportion with a 95% confidence interval was derived from a meta-analysis of various outcomes (CI).</p><p><strong>Results: </strong>A total of 33 studies comprising 610 patients treated with EVT were included for analysis which comprised one randomized control trial, one prospective study and 31 retrospective studies. Based on pooled data, 85% of patients had good functional outcome, 62% had complete recanalization, 5% had all-cause mortality, and 3% had catheter related complications. The efficacy outcomes in this analysis had a significant heterogeneity and a subgroup analysis was also done to explain these findings. The minimum time of follow up was 3 months and varied EVT techniques were used across the studies.</p><p><strong>Conclusion: </strong>This meta-analysis suggests EVT may be safe and efficacious in treating patients with severe CVT.</p><p><strong>Registration: </strong>Our protocol was registered with PROSPERO: International prospective register of systematic reviews with the registration number CRD42021254760.</p>","PeriodicalId":15218,"journal":{"name":"Journal of Central Nervous System Disease","volume":" ","pages":"11795735221131736"},"PeriodicalIF":4.8,"publicationDate":"2022-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/5f/5a/10.1177_11795735221131736.PMC9530583.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33492899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on: Neurological Manifestations Associated With SARS-CoV-2 in Children: A Case Series.","authors":"Josef Finsterer","doi":"10.1177/11795735221123915","DOIUrl":"https://doi.org/10.1177/11795735221123915","url":null,"abstract":"DECLARATION OF CONFLICTING INTERESTS: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. FUNDING: The author(s) received no financial support for the research, authorship, and/or publication of this article.","PeriodicalId":15218,"journal":{"name":"Journal of Central Nervous System Disease","volume":" ","pages":"11795735221123915"},"PeriodicalIF":4.8,"publicationDate":"2022-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b0/b5/10.1177_11795735221123915.PMC9478691.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40364057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rho-Kinase inhibition decreases focal cerebral ischemia-induced glial activation in rats.","authors":"Abdullah Md Sheikh,&nbsp;Shozo Yano,&nbsp;Shingo Mitaki,&nbsp;Shatera Tabassum,&nbsp;Shuhei Yamaguchi,&nbsp;Atsushi Nagai","doi":"10.1177/11795735221123910","DOIUrl":"https://doi.org/10.1177/11795735221123910","url":null,"abstract":"<p><strong>Background: </strong>Rho-kinase inhibition in a rat middle cerebral artery occlusion (MCAO) model is reported to improve neurological functions and decrease infarction size.</p><p><strong>Objective: </strong>The objective of this study is to investigate the underlying mechanisms of such improvement by evaluating the effects of Rho-kinase inhibition on astrocytes and microglial accumulation and activation in this condition.</p><p><strong>Methods: </strong>Adult male Sprague-Dawley (SD) rats were used to generate the MCAO model, which received an I.P injection of a chemical Rho-kinase inhibitor (Fasudil- 5 mg/kg/day) or vehicle (PBS) for 2 and 4 days.</p><p><strong>Results: </strong>Fasudil treatment significantly decreased the stroke volumes and water content in the lesion areas, as revealed by MRI. Immunostaining and Western blotting results demonstrated that Fasudil significantly decreased the levels of Aquaporin-4, a water channel protein. The number of GFAP⁺ astrocytes and Iba-1⁺ macrophage/microglia was decreased in the lesion areas. Proinflammatory transcription factor NF-κB protein levels were decreased in the Fasudil group 2 days after MCAO. Also, proinflammatory mediators including TNF-α, IL-1β, and iNOS levels were decreased. In vitro migration study using a human microglial cell line (HMO6) confirmed the inhibitory effects of Fasudil on the process. Fasudil also decreased combined IL-1β and IFNγ-induced NF-κB nuclear translocation in HMO6. Moreover, Fasudil transiently decreased combined IL-1β and IFNγ-induced iNOS, TNFα, and IL-1β mRNA levels in HMO6.</p><p><strong>Conclusion: </strong>Our study demonstrates the inhibitory effects of Rho-kinase on NF-κB-mediated glial activation and cerebral edema, which might be a promising therapeutic target in acute cerebral ischemia conditions.</p>","PeriodicalId":15218,"journal":{"name":"Journal of Central Nervous System Disease","volume":" ","pages":"11795735221123910"},"PeriodicalIF":4.8,"publicationDate":"2022-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6d/f0/10.1177_11795735221123910.PMC9465613.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40358840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The sequential natalizumab - alemtuzumab therapy in patients with relapsing forms of multiple sclerosis (SUPPRESS) trial - Part I: Rationale and objectives.","authors":"Rehana Z Hussain,&nbsp;Peter V Sguigna,&nbsp;Annette Okai,&nbsp;Crystal Wright,&nbsp;Mariam Madinawala,&nbsp;Ann D Bass,&nbsp;Gary R Cutter,&nbsp;Navid Manouchehri,&nbsp;Olaf Stuve","doi":"10.1177/11795735221123911","DOIUrl":"https://doi.org/10.1177/11795735221123911","url":null,"abstract":"Background Natalizumab is a recombinant humanized monoclonal antibody (mAb) against α4-integrin that is approved for relapsing forms of multiple sclerosis (MS). Natalizumab is associated with an increased risk of developing progressive multifocal leukoencephalopathy (PML), and with disease reactivation after cessation of treatment that is likely mediated by an accumulation of pro-inflammatory lymphocytes in the blood during therapy. Alemtuzumab is a mAb against CD52 that reduces the number of peripheral lymphocytes. Rationale To determine if treatment with alemtuzumab after natalizumab reduces disease activity in patients with relapsing forms of MS. This review article will outline the rationale and objectives of the sequential natalizumab – alemtuzumab therapy in patients with relapsing forms of multiple sclerosis (SUPPRESS; ClinicalTrials.gov ID: NCT03135249) trial in greater detail than would be feasible in a manuscript that summarizes the study results. Methods The SUPPRESS trial is single arm, open-label, multicenter, efficacy pilot study that aims to establish a disease-free state over a 24-months period in patients who received the natalizumab- alemtuzumab sequential therapy. Participants will be recruited from four different sites. The primary endpoint is the annualized relapse rate (ARR) from the time of cessation of natalizumab treatment. Key secondary endpoint is freedom of relapse at 12-months, the number of new/enlarging T2 lesions on magnetic resonance imaging (MRI), and the number of gadolinium (Gd)-enhancing lesions on MRI. An exploratory endpoint is the Expanded Disability Status Scale (EDSS), retinal nerve fiber layer (RNFL) thickness assessment by optic coherence tomography (OCT) and assessment of quality of life (QoL) measures by a pre-defined, self-administered testing battery. To evaluate immunological effects, blood leukocytes will be collected and immunophenotyped by multi-parameter flow cytometry. Conclusion The SUPPRESS trial will provide clinical, imaging, and biological data to determine whether sequential natalizumab to alemtuzumab combination therapy establish a disease-free state in patients with relapsing forms of MS.","PeriodicalId":15218,"journal":{"name":"Journal of Central Nervous System Disease","volume":" ","pages":"11795735221123911"},"PeriodicalIF":4.8,"publicationDate":"2022-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ef/6a/10.1177_11795735221123911.PMC9434668.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40349979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How do patients with secondary progressive multiple sclerosis enrolled in the EXPAND randomized controlled trial compare with those seen in German clinical practice in the NeuroTransData multiple sclerosis registry?","authors":"Stefan Braune,&nbsp;Arnfin Bergmann,&nbsp;Vladimir Bezlyak,&nbsp;Nicholas Adlard","doi":"10.1177/11795735221115912","DOIUrl":"https://doi.org/10.1177/11795735221115912","url":null,"abstract":"<p><strong>Background: </strong>In EXPAND (NCT01665144), a phase 3 randomized clinical trial, siponimod reduced disability progression versus placebo in patients with secondary progressive multiple sclerosis (SPMS).</p><p><strong>Aim: </strong>To understand how a real-world population with SPMS relates to that in EXPAND, we conducted a retrospective, observational cohort study using the German NeuroTransData (NTD) multiple sclerosis (MS) registry.</p><p><strong>Methods: </strong>The NTD MS registry is run by a Germany-wide network of physicians. Two cross-sectional analyses were performed using the NTD MS registry. The first included patients with SPMS, as recorded in the registry, and compared their characteristics between 1 January 2018 and 31 December 2018 with patients in EXPAND. The second described the characteristics of patients in the registry at the time of diagnosis of SPMS between 1 January 2010 and 31 December 2018.</p><p><strong>Results: </strong>The first analysis included 773 patients: patients were older in the NTD MS registry than in EXPAND (mean age, 57.9 vs 48.0 years) and had a longer duration of SPMS (mean, 6.2 vs 3.8 years). In the NTD MS registry, median Expanded Disability Status Scale (EDSS) scores were comparable to EXPAND (6.0 <i>versus</i> 6.0), although fewer patients had relapses in the previous 24 months (16% vs 36% [siponimod] and 37% [placebo]). Data on gadolinium-enhancing lesions were only available for 5.8% of patients in the NTD MS registry. The second analysis included 916 patients: at the time of SPMS diagnosis, the mean age was 53.2 years and the median EDSS score was 5.0.</p><p><strong>Conclusion: </strong>The population in the NTD MS registry was older to that in EXPAND, but were similar in terms of disability. Differences likely reflect the inclusion criteria of EXPAND but also highlight that real-world populations encompass a wider range of patient characteristics.</p>","PeriodicalId":15218,"journal":{"name":"Journal of Central Nervous System Disease","volume":" ","pages":"11795735221115912"},"PeriodicalIF":4.8,"publicationDate":"2022-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d8/a4/10.1177_11795735221115912.PMC9358581.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40691116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utilization of a neurology specialty service by primary care providers for headache management at a tertiary care hospital.","authors":"Samra Vazirian,&nbsp;Travis Ho,&nbsp;Rick A Weideman,&nbsp;Meagen R Salinas,&nbsp;Paul W Hurd,&nbsp;Olaf Stuve","doi":"10.1177/11795735221113102","DOIUrl":"https://doi.org/10.1177/11795735221113102","url":null,"abstract":"<p><strong>Background: </strong>Recent data indicate that the three-month prevalence of severe headaches or migraines in the US general population is close to 25%. Participation of primary care providers will therefore be critical in providing care to affected individuals.</p><p><strong>Objective: </strong>To determine the number of headache disorder consult requests to a neurology outpatient service in a tertiary medical center, the appropriateness of the consult requests, and the effectiveness of a lecture series on headache diagnosis and management in preventing inappropriate consult requests from non-neurology providers.</p><p><strong>Methods: </strong>Clinical data on US Veterans is captured and documented in the Veterans Health Information Systems and Technology Architecture (VISTA). The Computerized Patient Record System (CPRS) electronic medical record (EMR) was used for data entry and retrieval. All consult requests for the study period within the VA North Texas Health Care System were identified in VISTA, and the clinical information reviewed in CPRS. Based on a defined algorithm, headache consult request were categorized as appropriate or inappropriate. A board-certified neurologist provided four in-person/virtual lectures to ambulatory care providers, primary care providers, internal medicine residents, and emergency room providers within the VA North Texas Health Care System on the diagnosis and management of headaches. Prior and post the lecture series, the total number of headache consults per day was assessed over 45-day periods.</p><p><strong>Results: </strong>The number of daily headache consult requests in the 45-day period prior to the lecture series was 3.6 per day (standard deviation 2.7), and 6.0 per day after the lecture series (standard deviation 2.1). The difference was not statistically significant. There were as many inappropriate headache consult requests after the lecture series as appropriate ones (50% each).</p><p><strong>Conclusion: </strong>We found that a short-term educational initiative that instructed primary care providers on the diagnosis and management of common headache disorders did not reduce the number of consultation requests and, surprisingly, it did not improve the appropriateness of the consults. Given the prevalence of headaches in the general population, better training of all primary care providers in headache management should be pursued.</p>","PeriodicalId":15218,"journal":{"name":"Journal of Central Nervous System Disease","volume":" ","pages":"11795735221113102"},"PeriodicalIF":4.8,"publicationDate":"2022-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/53/cd/10.1177_11795735221113102.PMC9290155.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40609985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vessel wall imaging in COVID-19 associated carotid atherothrombosis and stroke: a case report and literature review.","authors":"Mohamad Syafeeq Faeez Md Noh,&nbsp;Abdul Hanif Khan Yusof Khan,&nbsp;Mohd Naqib Mohd Sabri,&nbsp;Mohd Fandi Al-Khafiz Kamis,&nbsp;Mohd Naim Mohd Yaakob,&nbsp;Ezamin Abdul Rahim,&nbsp;Ahmad Sobri Muda","doi":"10.1177/11795735221112589","DOIUrl":"https://doi.org/10.1177/11795735221112589","url":null,"abstract":"<p><p>COVID-19 associated neurological syndromes, including acute ischemic stroke, pose a challenge to treating physicians. The role of MRI in aiding diagnosis and further management is indispensable. The advent of new MRI sequences such as vessel wall imaging (VWI) allows an avenue in which these patients could be better investigated and treated. We describe our experience in managing a patient with COVID-19 associated atherothrombosis and stroke, focusing on the VWI imaging findings.</p>","PeriodicalId":15218,"journal":{"name":"Journal of Central Nervous System Disease","volume":" ","pages":"11795735221112589"},"PeriodicalIF":4.8,"publicationDate":"2022-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ab/78/10.1177_11795735221112589.PMC9272477.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40591744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neurofilament Light in Cerebrospinal Fluid is Associated With Disease Staging in European Lyme Neuroborreliosis.","authors":"Helene Mens,&nbsp;Lasse Fjordside,&nbsp;Rosa M M Gynthersen,&nbsp;Mathilde T Ørbæk,&nbsp;Åse Bengaard Andersen,&nbsp;Ulf Andreasson,&nbsp;Kaj Blennow,&nbsp;Finn Sellebjerg,&nbsp;Henrik Zetterberg,&nbsp;Anne-Mette Lebech","doi":"10.1177/11795735221098126","DOIUrl":"https://doi.org/10.1177/11795735221098126","url":null,"abstract":"<p><strong>Background: </strong>Drivers of differences in disease presentation and symptom duration in Lyme neuroborreliosis (LNB) are currently unknown.</p><p><strong>Objectives: </strong>We hypothesized that neurofilament light (NfL) in cerebrospinal fluid (CSF) would predict disease location and sequelae in a historic LNB cohort.</p><p><strong>Design: </strong>Using a cross-sectional design and archived CSF samples from 185 patients diagnosed with LNB, we evaluated the content of NfL in the total cohort and in a subgroup of 84 patients with available clinical and paraclinical information.</p><p><strong>Methods: </strong>Individuals were categorized according to disease location: a. Central nervous system (CNS) with stroke (N=3), b. CNS without stroke (N=11), c. Peripheral nervous system (PNS) with cranial nerve palsy (CNP) (N=40) d. PNS without CNP (N=30). Patients with hospital follow-up more than 6 months after completed antibiotic therapy were categorized as having LNB associated sequelae (N=15).</p><p><strong>Results: </strong>At diagnosis concentration of NfL exceeded the upper reference level in 60% (105/185), especially among individuals above 30 years. Age-adjusted NfL was not found to be associated with symptom duration. Age-adjusted NfL was significantly higher among individuals with CNS involvement. Category a. (stroke) had significantly higher NfL concentrations in CSF compared to all other categories, category b. (CNS involvement without stroke) had significantly higher values compared to the categories of PNS involvement. We found no significant difference between the categories with PNS involvement (with or without CNP). Significantly higher NfL was found among patients with follow-up in hospital setting.</p><p><strong>Conclusion: </strong>Comparison of NfL concentrations between the 4 groups of LNB disease manifestations based on clinical information revealed a hierarchy of neuron damage according to disease location and suggested evolving mechanisms with accelerated injury especially when disease is complicated by stroke. Higher values of NfL among patients with need of follow-up in hospital setting suggest NfL could be useful to identify rehabilitative needs.</p>","PeriodicalId":15218,"journal":{"name":"Journal of Central Nervous System Disease","volume":" ","pages":"11795735221098126"},"PeriodicalIF":4.8,"publicationDate":"2022-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/54/a6/10.1177_11795735221098126.PMC9272052.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40591743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}